The Department of Health Care Services (DHCS) works with Managed Care Plans (MCPs) to implement regular Performance Improvement Projects (PIPs) targeted at making improvements to specific service areas to enhance overall service quality and health outcomes of members. In 2023, CenCal Health began two multi-year PIPs to be completed in 2026, with one non-clinical PIP and one clinical PIP.
The Non-Clinical PIP aimed to improve the percentage of provider notifications delivered for members with substance use disorders (SUD) and/or serious mental health (SMH) diagnoses following or within seven days of an emergency department (ED) visit. The Clinical PIP focused on improving Well-Child Visits in the First 15 Months for CenCal Health’s Hispanic/Latino population.
These efforts support the goal of improving member health outcomes, functional status, and overall quality of life by addressing medical, behavioral, and social drivers of health. The final submission of these projects is complete and was submitted to DHCS in August 2026.
Non-Clinical PIP
The non-clinical PIP focused on the implementation of an Emergency Department Report on the Provider Portal. This intervention has been adopted by the plan and seeks continual improvement in follow-up rates after an ED visit for substance abuse and mental health disorders. This report can be accessed through individual provider portal accounts and displays a list of members recently seen in the ED and the due date for a timely follow-up. The final submission report on the efficacy of this intervention was submitted in August 2026 and compares the baseline period of calendar year 2023 to the remeasurement period of 2025.
CenCal Health is dedicated to supporting its PCPs in providing high-quality care for patients with substance use or mental health diagnoses. By improving the timeliness of ED visit notifications, we aim to enhance patient outcomes and support better care coordination. We encourage all PCPs to utilize this report. Thank you for your continued commitment to patient care.
Best Practices
- Establish a workflow to check the Provider Portal report daily to identify patients needing follow-up.
- Upon member ED use identification, schedule follow-up appointments within seven days.
- Develop a tracking method for patients due or past due for follow-up after discharge.
Clinical PIP
To improve rates of well-child visits for this population, multiple interventions were conducted. CenCal Health enhanced the Well-Baby Opportunity Report to include race/ethnicity to support targeted outreach on behalf of PCPs for this population. Additionally, CenCal Health’s Health Promotion team began partnering with Community Health Workers in Santa Barbara County to connect members to available resources and support patient navigation for families of young children to improve healthcare utilization. CenCal Health also partnered with local community-based organization, Family Service Agency, to educate and equip advocates with information and resources that can be shared with the families they serve.
The final submission reports on the percentage of Hispanic/Latino members who had six or more well-child visits with a PCP during their first 15 months of life for calendar year 2025. This rate is compared to the baseline period of calendar year 2023 to identify statistically significant improvement.
CenCal Health continues to assess areas of need within pediatric preventive health measures and seeks to ensure that all children receive the preventive health care they need. We are dedicated to supporting our providers in providing high-quality care for our youngest members.
Best Practices
- Utilize the Well-Baby Opportunity Report, located on the Provider Portal, to capture members at risk of falling behind on visits.
- Adhere to the scheduling recommendations of the Bright Futures/American Academy of Pediatrics Periodicity Schedule.
- Connect members with available resources, such as the CenCal Health Transportation Benefit. For more information, contact Member Services at 1-877-814-1861.
For further questions or support, please reach out to the Population Health team at [email protected].